Assessment Framework for Nursing Practice
Nursing is a practice profession involving application of knowledge from a variety of
sources into specific clinical situations. The knowledge necessary for nursing practice
can be thought of in relation to the four core nursing concepts: client, health,
environment and nursing.
Client
The client of nursing is the specific focus of nursing’s assessment, planning,
intervention and evaluation. Depending on the context of nursing practice or the
demands of a particular situation, the client of nursing may be an individual, a family, a
community, or a population. The conceptualization of each type of client creates a
framework for the entry issue, the orientation and the goal of nursing practice. The
manner in which the nurse systematically gathers, interprets and acts on information
relative to the client is articulated in distinct assessment frameworks for each of these
clients.
Systematic nursing assessment of the individual as client is a prominent focus of basic
nursing education, and the aspect that has attracted the preponderance of nursing
theoretical attention. The UBC School of Nursing Assessment Framework for Nursing
Practice is therefore most fully developed in relation to the individual client, and this
aspect serves as a core clinical competency throughout the basic baccalaureate
program. However, regardless of the context of practice, nursing practice also draws
upon systematic assessment in relation to family, community, or population as client.
These aspects of assessment are introduced within this document and will continue to
be developed through knowledge integrated into learning experiences throughout the
program.
Health
Health is an ever-changing and evolving multi-faceted dimension of human experience.
It is in the nature of individuals, families, communities or populations to strive for optimal
health, which can be conceptualized as the best possible level of wellness or
functioning that is achievable for them at any particular time. Health is influenced by a
range of determinants originating within individuals, groups and societies as well as in
the environment.
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Environment
Environment refers to the internal dimensions and external surroundings that affect the
health of the client of nursing. It involves a number of contexts in which the client exists:
familial, social, cultural, physical, global, historical. It may also involve the community
resources available, the geographical and political issues that affect health status, and
the health care system to which the client has access.
Nursing
Nursing is distinguished by the attributes, characteristics and actions of the nurse on
behalf of the client. The goal of nursing is to assist individuals, families, communities
and populations to achieve optimal health. Depending on the nature of the health or
illness issues by which the client and nurse enter a relationship with one another,
nursing care can be promotive, preventive, curative, rehabilitative, and/or supportive in
nature.
The nurse engages in a systematic process of reasoning throughout the provision of
nursing care. This process is traditionally referred to as the “nursing process.” It is
comprised of a sequential and cyclical set of intellectual operations, which are
assessment (including diagnosis), planning, implementation, and evaluation.
Nursing practice occurs in the context of human communication and interaction
between nurses, clients and others involved in health care. The nurse and client each
bring unique forms of knowledge, experience and meaning to the context of nursing
care. The nurse applies knowledge from a variety of sources to each unique client
encounter through a process of systematic reasoning guided by a philosophy of nursing
practice and a framework for systematic assessment and interpretation of information.
In this process, the nurse uses critical thinking approaches to review and interpret
empirical knowledge, raise questions in relation to individual contexts, validate
information, and propose approaches to client care. The effective and appropriate
application of evidence-based knowledge to unique client contexts requires the nurse’s
expert opinion using the processes of systematic data gathering, cue and pattern
recognition, logical inference, diagnostic reasoning, and clinical decision-making.
Nursing practice is grounded in the nurse’s unique capacity to use a systematic
reasoning process to understand the individual as client. What distinguishes nursing
practice at the family, community and population levels is the nurse’s capacity to
appreciate the individuals within those groups in a particular way as well as to
understand those larger and more complex systems within which individuals are
embedded. Whether the specific client of nursing is the individual, the family, the
community, the population, or any combination of these at any particular time, nursing is
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distinguished by the capacity to reason systematically using the nursing process, draw
upon knowledge that is shared with other disciplines as well as that which is unique to
nursing, and apply a conceptual orientation to understanding the uniqueness of each
client of nursing. The nurse practices within the parameters of professional standards
and a code of ethics.
Systematic Assessment Frameworks for Nursing
Individual as Client
In the UBC School of Nursing Assessment Framework for Nursing Practice, the
individual is viewed as a biological, psychological, social, cultural, sexual and spiritual
being. In order to provide a systematic way of conceptualizing the integrity and
interrelatedness of each of these dimensions, this Framework represents the complexity
of the human person as being comprised of a common set of eight distinct but
interrelated basic human needs. Each of these needs contributes to motivating human
behavior in different ways at different points within the lifecycle and in different life
contexts, and therefore understanding each of the eight needs individually and in
interaction creates an organizing structure by which an infinite range of human health
and illness experiences can be systematically interpreted and understood. In this
Framework, the eight needs that make up the human system are conceptualized as the
needs for: Safety, Elimination, Energy Balance, Self-Worth, Oxygenation, Nutrition,
Connection, and Purpose. These needs operate in constant interaction with one
another, and may at various times rise to prominence in an individual’s focus of
attention or concern. Some of these needs require maintenance of an ongoing level of
need satisfaction in order for immediate physiological survival; others represent a
significant threat to optimal health only when they are chronically unmet over time.
Individuals strive to meet these basic needs through use of diverse strategies.
Nurses recognize that the individual’s ability to meet any or all of these needs can be
actually or potentially compromised by various health situations, including illnesses, life
transitions, or other life events. Needs that are unmet represent a specific focus of
analysis and intervention for nurses because they may lead to a range of untoward
client outcomes, including sub-optimal health, disease, illness, or in some instances,
death. An individual client’s capacity to strive toward optimal health is determined by his
or her ability to meet these basic human needs; thus, the nurse’s focus of attention is on
assisting the client to meet each need as fully and meaningfully as possible, and in a
manner which does not interfere with his or her ability to concurrently meet other needs.
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The nurse and the client together define and negotiate strategies for reaching
satisfaction of each of the needs and moving toward optimal health. By attending to the
external and internal factors influencing need satisfaction, and to the behaviors that an
individual is using to try to meet his or her needs, the nurse attempts to ensure that the
client’s attempts to meet one need are not jeopardizing his or her ability to meet other
needs, and that the system of needs remains in balance. In so doing, the nurse
supports the individual toward reaching optimal health.
Basic human needs are universal in that they are understood to characterize what is
fundamental to all persons, regardless of life stage or health status. However, nursing
recognizes that individuals are sensate, interpretive beings with unique and distinctive
goals related to each of the needs. General knowledge about basic human needs
provides an important general and theoretical background to understanding individuals.
Using objective and subjective data, the nurse can draw general conclusions about
basic human needs. However, individualized nursing care inherently requires an
understanding of the particular need-related goals that each individual holds in order to
determine whether needs are being fully met and to evaluate the individual’s status in
relation to what constitutes optimal health for that person. This individualized
understanding arises from both the objective and the subjective information that a nurse
acquires and interprets in the context of the nurse-client relationship, an understanding
of the unique internal and external environmental context relevant to that individual, and
an appreciation for the full range of determinants of health that may be influential upon
the need-satisfaction and/or optimal health of the person at any point in time.
Individual Client Systematic Assessment Framework
Each need is understood as an abstraction representing something that is universal
about being human. Nurses understand all persons as inherently striving toward
meeting that need, each in his / her own way, regardless of whether or not we have
direct evidence of that striving. Although we never see the need directly, we come to
know an individual’s need-related goals by understanding each person’s unique ways of
striving toward need satisfaction. The goals listed below are examples of what some
individuals might value; by understanding individual goals we come to appreciate the
uniqueness of each individual client in relation to meeting these universal needs. In
order to guide assessment so that we can begin to understand the individualized goals
for each client, possible areas for assessment are also listed below. As the nurse
develops sophistication with assessment and integrates an increasing body of
substantive knowledge in to the process of gathering client data, the strategies he or
she will use for assessment become refined, and the foci for assessment will be
adapted to individual contexts of practice and diverse client populations. In learning to
use a framework, nursing students begin with a common (and sometimes prescriptive)
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set of foci for assessment under the guidance of their teachers and mentors. As they
develop in their competence with assessment, they will apply increasingly complex
clinical reasoning to this process over time and grow in their capacity to identify relevant
assessment strategies across clinical contexts.
NEED (Understood as
Human Universal)
SAFETY
This need represents the
need of all persons for
protection against harm,
and for safety and
security. It is reflected in
the capacity to maintain
the integrity of the
person in a changing and
complex environment
Examples of Individualized
Need-Related GOALS
Examples of Possible Foci
for ASSESSMENT
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ELIMINATION
This need represents the
requirement for collection
and removal of waste from
the human system
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ENERGY BALANCE
This need represents the
requirement for balancing
energy in order to preserve
stamina, regeneration, and
to participate in meaningful
activity
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Protection form harm
Predicting and
controlling for health risk
factors
Managing anxiety and
fear
Obtaining adequate
income and housing
Optimal functioning of
the system’s senses
Freedom from physical
discomfort
Wound healing
Feeling safe
Prevention of metabolic
and respiratory waste
product buildup
Comfortable and
effective bowel and
bladder function
Avoidance of fatigue
Sufficient energy levels
to sustain activity
Capacity for restful
sleep
Avoidance of fatigue
Sufficient energy levels
to sustain activity
Capacity for restful
sleep
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Sensory fun and
satisfaction
Fear and anxiety
Emotional comfort
Physical
comfort/freedom from
pain
Cultural safety
Judgment and insight
Protection from
predictable harm
Skin and physiological
system integrity
Hygiene
Removal of waste from
urinary tract,
gastrointestinal system,
skin and lungs
Physiological indicators
of metabolic function
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Energy level
Sleep patterns
Barriers to sleep
(emotional tension or
physical discomfort)
Rest and relaxation
strategies
Physical activity
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SELF-WORTH
This need has to do with
the essential requirement
that we all have for selfunderstanding and valuing
of the self
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OXIGENATION
This need represents the
requirement of intake and
circulation of adequate
levels of O2.
NUTRITION
This need has to do with
adequate levels of food and
fluid to nourish and hydrate
the body
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Positive personal
identity
Feelings of self-esteem
Positive body image
Ability to engage in
meaningful interactions
with others
Comfort with sexual
identity
Self-awareness
Sense of
accomplishment
Physiological indicators
of O2 and CO2
Integrity of circulatory
system
Comfort with breathing
Adequate intake to
maintain optima
physiological functioning
Absorption and uptake
of nutritional elements
Hydration
Satisfaction of hunger
and thirst
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CONNECTION
This need reflects the
human requirement to
create and sustain
meaningful relationships
throughout the lifespan.
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Meaningful, trusting,
respectful and
supportive interpersonal
relationships
Meaningful participation
in family, community
and/or society
Relationship with some
higher power, creative
force, divine being, or
infinite source of energy
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Role satisfaction
Subjective indicators of
feelings of worthiness
Feelings of satisfaction
with accomplishments
Sense of personhood
Issues related to
procreation/sexuality/se
xual activity
Threats to dignity
Insight
Physiological indicators
of O2 and CO2
Integrity of circulatory
system
Indicators of adequate
tissue oxygenation
Lung capacity
Vital signs
Access to appropriate
food and fluid
Dietary preferences
Physiological indicators
of nutritional status
Ability to chew, swallow,
digest effectively
Appropriate intake to
maintain healthy body
weight
Patterns of eating and
drinking
Comfort/enjoyment with
eating and drinking
Social support
Interpersonal
relationships
Capacity for emotional
attachment, intimacy,
affection
Issues related to
procreation/sexuality/se
xual activity
Issues related to
dependence and
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PURPOSE
This need reflects the
innate human striving for a
sense of meaning in life.
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Feelings of satisfaction
with accomplishments
Having meaningful work
Making meaning of life’s
events and challenges
Spiritual meaning
Creating a legacy of
one’s life
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interdependence
Sociocultural identity
Spirituality
Human developmental
stages and tasks
Occupation/activities
Education
Family/relationships
Spirituality
Creativity
Generativity
Family, Community and Population Assessment Frameworks for
Nursing Practice
Nursing at the family, community and population levels requires that the nurse builds
upon understanding systematic assessment at the individual level and expands the
same clinical reasoning processes into a broader scope of analysis and influence. At
the UBC School of Nursing, we use a range of frameworks in addition to the Individual
Assessment Framework for Nursing Practice to facilitate systematic thinking across
these client contexts. The specific frameworks will be introduced within the
undergraduate curriculum in courses such as NURS 312 (Family Nursing) and NURS
413 (Community and Population Health).
General Definitions of Family, Community and Population as Client
Family as Client: The family is “who they say they are” (Wright & Leahey (2000). The
definition of who is a member of a particular family may be various and dynamic over
time to include members who are both present and absent (such as ancestors), and
human and non-human (such as pets). When the nurse identifies one or more
individuals within a family as client the family itself may also be identified as a distinctive
client. Families strive for optimal health of individual members and of the family itself.
Family structures and family processes contribute to the day-to-day functioning of the
family, and to the capacity for responding to health or illness situations Likewise, health
and illness situations affect family structure and processes. The nurse supports the
maintenance and/or development of family processes and structures aimed at the goal
of optimal health.
Community as Client: “A community is a specific group of people, often living in a
defined geographical area, who share a common culture, values and norms, are
arranged in a social structure according to relationships which the community has
developed over a period of time. Members of a community gain their personal and
social identity by sharing common beliefs, values and norms which have been
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developed by the community in the past and may be modified in the future. They exhibit
some awareness of their identity as a group and, share common needs and a
commitment to meeting them” (WHO, 1998, p. 5). Nurses working with community as
client recognize that “a community’s health is inextricably linked with the health of its
constituent members and is often reflected first in individual and family health
experiences. Healthful communities and systems that support health, in turn, contribute
to opportunities for health for individuals, families, groups and populations” (CHNAC,
2003).
Population as Client: A population is a “collection of individuals who have one or more
personal or environmental characteristics in common” (Stanhope & Lancaster, 2000, p.
9). Nurses practice population health promotion in a range of diverse settings, “such as
community health centres, schools, street clinics, youth centres and nursing outposts,
and with diverse partners, to meet the health needs of specific populations“ (CHNAC,
2003). They synthesize knowledge “from public health science, primary health care
(including the determinants of health), nursing science, and theory and knowledge of
the social sciences to promote, protect, and preserve the health of populations”
(CHNAC, 2003).
References
Community Health Nurses Association of Canada. (2003). Canadian community health
nursing standards of practice.
Stanhope, M., & Lancaster, J. (2000). Community and public health nursing (5th
ed.), St. Louis: Mosby.
World Health Organization. (1998). Health promotion glossary. Geneva: Author.
Wright, L. M., & Leahey, M. (2000). Nurses and families: A guide to family assessment
and intervention (3rd ed). Philadelphia, PA: F.A. Davis Company.
Supporting Reference Documents
The following documents were reviewed and utilized in the development of the
Framework for Nursing Practice:
Arnold, E., & Boggs, K. U. (2001). Interpersonal relationships: Professional
communication skills for nurses (4th ed.). Toronto: Saunders.
Boyd, M.A. (2002). Psychiatric nursing: Contemporary practice. Philadelphia:
Lippincott.
Du Gas, B.W., Esson, L., & Ronaldson, S.E. (1999). Nursing foundations: A Canadian
perspective (2nd ed.). Scarborough: Prentice Hall.
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Henderson, V. (1966). The nature of nursing. New York: Macmillan.
Kozier,B., Erb, G., Berman, A., & Snyder, S. (2004). Fundamentals of nursing:
Concepts, Processes and Practice (7th ed.). Pearson Prentice Hall: New Jersey.
Thorne, S. (1995). The UBC Model for nursing practice: An integrative summary.
Author.
Thorne, S. (1997). Some values associated with systematic thinking in nursing practice.
Submitted to UBC Undergraduate Programs Committee. Author.
Thorne, S. (2003). Theoretical issues in nursing. In J.C. Ross-Kerr & M.J.Wood, (Eds.),
Canadian Nursing: Issues and Perspectives (4th ed.) (pp.116-134). Toronto: Mosby.
Thorne, S., Jillings, C., Ellis, D., & Perry, J. (1993). A nursing model in action: The
University of British Columbia experience. Journal of Advanced Nursing, 18, 1259-1266.
Thorne, S., & Perry, J. (2001). Theoretical foundations of nursing practice. In P.A. Potter
& A.G. Perry, with, J.C. Ross-Kerr and M.J. Wood (Eds.), Canadian Fundamentals of
Nursing (2nd ed.) (pp.86-97). Toronto: Mosby.
UBC School of Nursing. (2003). UBC School of Nursing Beliefs Framework. Author.
UBC School of Nursing. (n.d.) Family Framework. Author.
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